The Lister Hospital Blog

What’s New in the Treatment Options for Psoriatic arthritis?

Published: 31/08/2016

Dr Sonya Abraham, Consultant Rheumatologist

MBBS FRCP PhD FHEA

Psoriasis (Pso) and psoriatic arthritis (PsA) are inter-related chronic inflammatory diseases. Psoriasis affects 2-3% of the UK population and 20-30% of individuals with psoriasis will develop a distinct form of arthritis termed PsA, usually in the first 10 years after onset of psoriasis. About 15% of patients develop PsA before Pso and the same proportion develop both conditions concurrently. The presence of skin psoriasis is a major risk factor for the development of an inflammatory form of arthritis. Additional risk factors included obesity, smoking, the presence of nail psoriasis and possibly the severity and distribution of psoriasis. Genetic factors are undoubtedly important in conferring risk for the development of psoriasis and PsA. There are independent genetic risk factors for the development of PsA in individuals with psoriasis that include HLA-B27, IL 13 and PTPN22, with HLA-B27 having the strongest association.

Psoriatic arthritis (PsA) is an inflammatory, chronic disease which can result in painful, swollen joints, joint erosions, dactylitis and enthesitis such as Achilles tendonitis. Additionally, a subgroup of PsA patients can present with chronic inflammatory back pain and sacroiliitis. There are extra-articular manifestations associated with PsA including Psoriasis, anterior uveitis, inflammatory bowel disease and metabolic syndrome.

Traditional treatments for PsA have included Non-steroidal anti-inflammatory drugs for mild disease and disease modifying small molecule drugs (DMARDs) including methotrexate, sulphasalazine, ciclosporin and leflunomide.

Psoriasis is non-scarring and may resolve completely although it tends to recur in the same distribution suggesting local factors are important in its generation. Conversely untreated, PsA can lead to joint damage with 27% of patients sustaining irreversible joint damage within the first 12 months. There are several recognisable clinical patterns of PsA that may overlap including oligoarthritis, polyarthritis, the predilection for distal interphalangeal involvement, and axial spine disease that is some cases may be indistinguishable from ankylosing spondylitis (AS). Also in common with other forms of spondyloarthritis there is an increased incidence of uveitis.

If you have psoriasis together with symptoms in your joints or tendons then you should consider consulting with a physician to exclude psoriatic arthritis.